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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500610
Report Date: 10/05/2023
Date Signed: 10/05/2023 05:02:40 PM

Document Has Been Signed on 10/05/2023 05:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NINAS EARLY LEARNING & CHILD CARE CENTERFACILITY NUMBER:
394500610
ADMINISTRATOR:MERCADO, JANELIFACILITY TYPE:
830
ADDRESS:2701 MICHIGAN AVETELEPHONE:
(209) 475-8871
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 21DATE:
10/05/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Paulina OsunaTIME COMPLETED:
05:15 PM
NARRATIVE
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On October 5th, 2023, at 1:00 pm, Licensing Program Analyst (LPA), David Nguyen conducted an announced field visit to the facility. LPA arrived at the facility and was met by Admin Director Paulina Osuna (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed twenty-one (21) children being supervised by five (5) adult teachers.

LPA observed the exposure notice of an outbreak of a communicable disease for Hand, Foot, and Mouth was placed on the table in the hallway for parents to see.

LPA determined through accessing Guardian that one (1) of the teachers was not cleared and/or associated to the facility. Based on observation and review, D1 did not ensure a criminal record clearance and/ or association of one of the staff members to her facility, which poses an immediate health, safety, or personal rights risk to persons in care.

A Type A violation was assessed on a subsequent 809-D page. Director shall post LIC 809-D with Type A deficiency for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Licensees.

LIC9224 and Appeal Rights were provided. An exit interview was conducted, and the report was reviewed with D1. Licensee Appeal Rights were provided to D1. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Director acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Director shall post LIC 809-D.


SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/05/2023 05:02 PM - It Cannot Be Edited


Created By: David Nguyen On 10/05/2023 at 03:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: NINAS EARLY LEARNING & CHILD CARE CENTER
FACILITY NUMBER: 394500610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/05/2023
Section Cited
CCR
101170(e)(1)

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101170 Criminal Record Clearance...
(e) All individuals subject to a criminal record review... prior to working...(1) Obtain a California clearance or a criminal record exemption as required by the Department...

This requirement was not met as evidenced by:
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Director will either associate the employees to the facility by transferring the fingerprint clearances or by obtaining new fingerprint clearance.
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Based on record review and interview, one staff member was not fully cleared nor associated to the facility which poses an immediate risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chayntel Hunter
LICENSING EVALUATOR NAME:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023


LIC809 (FAS) - (06/04)
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